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Women's Health Newsletters 11/14/99 - 12/26/99
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***** Woman's Diagnostic Cyber Newsletter *****
November 14, 1999
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Myths about breast feeding
3. Reader submitted Q&A - HPV and Cancer
4. Endometrial cancer clearly explained
5. Vasectomy Answers
6. Humor is healthy
For those of you who use Netscape Navigator as
your browser (not AOL users or Internet Explorer),
and use My Netscape as your customizable home
page, you can now add Woman's Diagnostic Cyber
News, an abbreviated form of this newsletter, as a
channel to your home page at My Netscape.
To do this, just visit our home page:
Home page
and click on the Netscape banner "add this site to
my Netscape" on the upper right page corner.
Spread the word! Send a copy of this newsletter
to someone you know.
Note: Some of the long URLs may not wrap as a
hyperlink and you may need to cut and paste.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Myths about breast feeding
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Many women mean well in telling you their health
stories, but breast feeding is a topic that seems
to attract inaccurate information. Myths such as:
Some women's breasts are too small for
breast feeding.
Breast feeding makes women gain weight.
Women who go back to work or use child care cannot
breast feed.
Breast feedingg ties women down too much.
Some women just run out of breast milk.
Bottle feeding is just as good for babies as
breast feeding.
seem to spread around and cause women to give up
breast feeding quickly. On the opposite side,
sometimes the medical profession can make a woman
feel guilty if she doesn't choose breast feeding.
This site at Mayo Health has something to say
about that also.
Breastfeeding folk wisdom and facts
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - HPV and Cancer
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I would like to know how accurate the tests are
that are out right now for the different strains
of HPV. I would like to have the test done if I
thought it was reliable in diagnosing if I have
the type(s) that is thought to lead to cervical
cancer. I am very concerned about HPV and
treatments and how from what I have heard that the
treatments are not very successful. Do you know?
There are two types of tests being used to
identify different types of HPV, especially the
high risk types for cervical cancer. One is to use
the tissue from a Pap or biopsy and check for DNA
fragments unique to HPV. The other test is one for
antibodies to the viral capsule. With over 90
different types of HPV it is difficult to say how
accurate testing is.
A large part of the answer to your question
depends upon why you want to know the subtype and
your understanding of what different treatment or
action will be taken depending upon the results.
For a discussion about HPV typeing tests, see:
HPV Type Associated with Cancer
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Endometrial cancer clearly explained
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
When the term - cancer of the uterus - is used, it
can actually refer to either cervical cancer or to
endometrial cancer. Pap smears screen for cancer
of the cervix but they are not a screening test
for endometrial cancer. Endometrial cancer peaks
in the 55-65 age range and is often diagnosed by
endometrial biopsy or D&C for abnormal uterine
bleeding.
The endometrium is the lining of the uterus that
is sloughed each month with menses during
reproductive years but then just remains
constantly present in the menopausal years.
One type of endometrial cancer is estrogen
sensitive or dependent and is associated with
conditions that elevate estrogen levels. These
might include polycystic ovarian disease or any
condition that causes irregular menses as well as
taking estrogens supplements or prescriptions
without taking additional progestin/progesterone
to block the effect on the endometrium.
The monograph below has a very good explanation of
endometrial cancer with a minimum of medical
jargon. It also explains about some of the
hyperplasia categories that can sometimes precede
invasive cancer.
Endometrial cancer
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Vasectomy answers
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Sometimes a partner needs a little prodding,
especially when it comes to having a sterilization
procedure. You may even need to lead him to more
information to counteract "locker room" myths.
He will want to know if it affects erection or
ejaculation (it doesn't) and if it causes any
medical diseases (no it does not). Other questions
such as "does it hurt?" and "how much does it
cost?" are answered at this AVSC (Access to
Voluntary and Safe Contraception) International
site.
Vasectomy answers
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
An old man goes to the doctor for his yearly
physical, his wife tagging along.
When the doctor enters the examination room, he
tells the old man: "I need a urine sample, a
stool sample and a sperm sample."
The old man, being hard-of-hearing, looks at his
wife and yells:
"What? What did he say? What's he want?"
His wife yells back, "He needs your underwear!"
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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***** Woman's Diagnostic Cyber Newsletter *****
November 21, 1999
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Food allergies
2. Estrogen in autoimmune diseases
3. Reader submitted Q&A-What are natural hormones?
4. Postpartum blues, depression or psychosis?
5. Low blood sugar - multicausal, not a disease
6. Humor is healthy
For those of you who use Netscape Navigator as
your browser (not AOL users or Internet Explorer),
and use My Netscape as your customizable home
page, you can now add Woman's Diagnostic Cyber
News, an abbreviated form of this newsletter, as a
channel to your home page at My Netscape.
To do this, just visit our home page:
Home page
and click on the Netscape banner "add this site to
my Netscape" on the upper right page corner.
Spread the word! Send a copy of this newsletter
to someone you know.
Note: Some of the long URLs may not wrap as a
hyperlink and you may need to cut and paste.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Food allergies
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Symptoms of allergies to foods can include:
vomiting, diarrhea, cramps, hives, swelling, a
skin rash or itching. Sometimes the reaction can
also cause a tightness in the throat, difficulty
breathing, or wheezing. These can start within
minutes or up to an hour after eating the
causative food.
Did you know that eight foods are the most common
causes of over 90% of food allergies: milk, egg,
wheat, peanut, soy, tree nuts, fish, and
shellfish? While almost 25% of people think they
have a food allergy, in fact only about 1-2% of
adults and up to 5% of children have legitimate
food allergies.
A big concern among people with food allergies is
that packaged foods need to be labelled correctly
because someone with a food allergy can die from a
mislabelled package. At the Food Allergy Network,
you can sign up for news alerts when, for example,
"Tyson Foods recalls packages of "Restaurant
Favorites" Chicken Breast Fajitas and Kirkwood
Chicken Fajita Kits for containing undeclared
milk." and "Swanson Frozen Foods recalls packages
of Great Starts French Toast Sticks breakfasts for
containing undeclared milk"
Food Allergy Network
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Estrogen in autoimmune diseases
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Many autoimmune diseases tend to occur in higher
frequency in women than men. For example, the
female-to-male susceptibility ratio is 9:1 for
systemic lupus erythematosus (SLE), 2:1 to 4:1 for
rheumatoid arthritis (RA), and 9:1 for Sjogren's
syndrome (SS). In thyroid disease, the female-to-
male ratio is over 25:1 for adult onset
Hashimoto's thyroiditis and over 4:1 for Graves
hyperthyroidism. Idiopathic adrenal insufficiency,
scleroderma, myasthenia gravis and autoimmune
diabetes mellitus also have from 2:1 to 5:1
female-to-male risk prevalence ratios.
Scientists theorize that women have exaggerated
responses to autoantigens and that perhaps
estrogens stimulate that "self-allergic" response
and /or androgens (male hormones) suppress that
response. It is not entirely clear, however,
because estrogens seem to worsen SLE but they
improve rheumatoid arthritis.
The study below does not answer all these
questions about hormones and immunity but points
out that the T-cells, which are central to the
immune response, are rich in cell receptors for
estrogen. Also, estrogens can stimulate antibodies
and androgens can suppress them. This may have
some implications for the use of antiestrogens or
androgens as treatment for autoimmune diseases in
women.
Estrogen in autoimmunity
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A-What are natural hormones?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
There is quite a bit of confusion about natural
hormones and estrogen replacement therapy.
Depending upon what you consider "natural" and
what attributes or advantages you think might be
associated with "natural", will govern what
supplements and what prescriptions you will seek
out.
Did you know that what most people consider as
natural estrogens have no lower incidence of
breast cancer or even other short term side
effects than other estrogens?
See our discussion at:
What is natural about natural hormones?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Postpartum blues, depression or psychosis?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Mothers may be suprised about occasional negative
thoughts they may have about a newborn baby. This
can be a normal part of the postpartum blues. In
about 10% of women, it can progress further into a
severe postpartum depression.
This may be manifest by constant fatigue,
emotional numbness, withdrawal from others in the
family, lack of concern for yourself or your baby,
sleep difficulties, decreased libido, and a sense
of failure and inadequacy. Women may even have too
high expectations, and be over demanding, or feel
trapped. If thoughts of hurting yourself or the
baby creep up, it is time to seek help
immediately.
The Mayo Health site below also has a brief quiz
assessment to see if you may already be depressed.
Postpartum depression
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5.Low blood sugar - multicausal, not a disease
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Hypoglycemia can be due to many different diseases
and conditions. It produces symptoms of fatigue,
dizziness, mood changes, anxiety, trembling hands,
concentration/attention disorders, visual
disturbances, memory problems, sleep difficulties,
headaches, and sudden sweating among others. Two
main types of chronic hypoglycemia are reactive
hypoglycemia and fasting hypoglycemia. Reactive
hypoglycemia often produces symptoms a couple of hours
after a simple carbohydrate load (pie, cake,
cookies, Coke). Fasting hypoglycemia produces
symptoms early in the morning before breakfast.
The abnormal physiologic condition is confirmed by
an extended glucose tolerance test (4-6 hours) and
then you need to make sure which of the many
causes may play a role: heredity, if
hypoglycemia or diabetes runs in the family;
weakened immune system, e.g. after a (viral)
infection; tumors, like an insulinoma; wrong
eating habits, esp. sugar intake; prolonged use of
refined food; prolonged use of drugs like
antibiotics; hormonal disorders; chronic stress,
bodily as well as mental; old infections, e.g.
Pfeiffer disease; pancreas overload; excess
physical exercise; food intolerance and allergies,
e.g. celiac symptoms and hypoglycemia symptoms can
be very look-alike, some people consider
hypoglycemia as a side-effect of their allergy or
intolerance.
The nice part about this condition is that diet
can control the symptoms.
Hypoglycemia symptoms and causes
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
History Of Medicine
2000 B.C. - Here, eat this root.
1000 A.D. - That root is heathen. Here, say this prayer.
1850 A.D. - That prayer is superstition. Here, drink this potion.
1940 A.D. - That potion is snake oil. Here, swallow this pill.
1985 A.D. - That pill is ineffective. Here, take this antibiotic.
2000 A.D. - That antibiotic is artificial. Here, eat this root.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Pointing you in the right health direction.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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***** Woman's Diagnostic Cyber Newsletter *****
November 28, 1999
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Choices of oral contraceptives - if and what
2. Cancer of the cervix in older women
3. Reader submitted Q&A - Fibroid treatments
4. Varicose veins
5. Your local area's water quality
6. Humor is healthy
Spread the word! Send a copy of this newsletter
to someone you know.
Note: Some of the long URLs may not wrap as a
hyperlink and you may need to cut and paste.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Choices of oral contraceptives - if and what
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Women are choosing or being recommended to take
oral contraceptive pills (OCPs) for more and more
reasons lately. Perimenopausal women may use OCPs
for stabilization of hormonal levels just before
menopause to reduce intermittent menopausal-type
symptoms. Women with abnormal uterine bleeding are
often prescribed OCPs for several cycles or more
to try to regulate the bleeding problem. Pills can
also be effective for reducing PMS symptoms in
many women and continuous OCPs (no 4th week break)
are used for endometriosis treatment.
Because so many women may end up taking OCPs for
non contraceptive reasons, it is helpful to review
the indications, contraindications and pros and
cons of different OCP formulations. A recent
comprehensive review article in American Family
Physician has some very useful tables and tips.
The article covers:
different formulations of pills and their brand
names,
1) the non contraceptive benefits of oral
contraceptive pills,
2) the World Health Organization precautions for the
use of oral contraceptive pills,
3) the cardiovascular and thromboembolism risks of
the pills
4) factors to consider in starting or switching oral
contraceptive pills
5) side effects of pills
6) and potential interactions between oral
contraceptive pills and selected drugs
Also there are sections on special groups of women
such as over 35, perimenopause, and adolescents
and which are the better pills to choose for those
groups of women.
OCP risks, formulations and benefits review
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Cancer of the cervix in older women
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
About one fourth of all cervical cancer occurs
after age 65. That is reason enough to continue
having Paps even after you think you don't want to
have any more pelvic exams. Over 40% of the deaths
from cancer of the cervix occur after age 65
probably because many women avoid continuing
regular exams and Paps and the disease gets
discovered at more advanced stages than it does
with regular exams.
Did you know that Medicare only pays for a Pap
smear every 3 years? If you have had regular exams
and no abnormal Paps, every three years for the
Pap smear (not the physical and pelvic exam) is
probably a reasonable cost-effective strategy. We
know that more than half of women over 65 HAVE NOT
had a Pap smear within 3 years. The moral of the
story is that you cannot forget and extend your
Paps out to more than 3 years because that is how
cancer becomes advanced before diagnosis.
Many physicians are more cautious than current
guidelines and would still recommend yearly Pap
smears over age 65 if you have ever had an
abnormal smear or a history of a human papilloma
virus (HPV) infection.
Cancer of the cervix in the elderly
Another fact sheet you may be interested in about
cancer of the cervix comes from the National
Cancer Institute - What you need to know about
cancer of the cervix. It describes:
What Is Cancer?
Precancerous Conditions and Cancer of the Cervix
Early Detection
Symptoms
Diagnosis
Treating Precancerous Conditions
Treating Cancer of the Cervix
Staging
Getting a Second Opinion
Preparing for Treatment
Methods of Treatment
Clinical Trials
Side Effects of Treatment
Surgery
Radiation Therapy
Chemotherapy
Biological Therapy
Nutrition for Cancer Patients
Followup Care
Support for Cancer Patients
Cancer of the cervix fact sheets (NCI)
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Fibroid treatments
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I have heard that there is a new technique for
removing uterine fibroids by injecting something
into the blood. Can you tell me something about
this? I'm not interested in a hysterectomy ".
Uterine fibroid embolization is probably the
procedure you are talking about. It involves
catheterization of the femoral arteries and
injecting polyvinyl alcohol microspheres to block
off the fibroid's blood supply. It can result in
moderate pain for 4-7 days. Its not a totally
benign procedure and needs to be compared to the
other non hysterectomy treatments for fibroids
such as:
myomectomy
laparoscopic myomectomy
hysteroscopic fibroid resection
laparoscopic myolysis
fibroid embolization
These are briefly discussed at:
Non Hysterectomy Fibroid Treatments Including Embolization
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Varicose veins
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Varicose veins, those large blue bulging cords on
the legs during pregnancy or those starburst
spider veins on the skin surface occur much more
commonly in women than in men. They also tend to
run in families so if mother had a problem with
varicose veins, you are more likely to have
problems also.
Other than wearing support hose and avoiding
prolonged standing, there is not much non surgical
treatment that can be done for varicose veins.
They get worse with age and many women submit to
surgical vein stripping. Spider veins can be
treated non surgically but they require injection
of a medication that scars the vein shut.
Treatment is usually a permanent disappearance of
the veins unless a person is obese and predisposed
to forming new varicosities.
Varicose veins
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Your local area's water quality
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Many of you recently may have received a report in
the mail from your municipal water supply
indicating what quantities of many different
chemicals are present in your water supply. This
report was the direct effect of a new Federal law
requiring all city water municipalities to
disclose a water quality report to each of its
customers. If you are on well water you would not
have received one of these. If you missed those
reports, the Water Utility Home Pages may have the
report for your city.
City Water Utility reports
You may be interested in the large amounts of
chemicals and pesticides that are applied to
various places each year and may in some amounts
make it into our water supply. Do you think
bottled water is always purer than tap water?
Sometimes it is not.
Detailed water information
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Blondes always take the hits, but God Knows
-=-=-=-=-=-=-
Three blonde men are stranded on one side of a
wide river, and don't know how to get across.
The first man prays to God to make him smart
enough to figure out how to cross the river, so
God turns him into a brown-haired man and he swims
across.
The second man prays to God to make him even
smarter, so God turns him into a dark-haired man
and he builds a boat and rows across.
Then the third man prays to God to make him the
smartest of all,
so God turns him into a woman and he walks across
the bridge.
Contributed by: Andrea
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Real world medical experience saves your time.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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***** Woman's Diagnostic Cyber Newsletter *****
December 5, 1999
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Marine wound infections
2. Effective treatment of hypertension
3. Reader submitted Q&A - Taking ClomidŽ
4. High caffeine intake and miscarriages
5. Thick toenails
6. Humor is healthy
Spread the word! Send a copy of this newsletter
to someone you know.
Note: Some of the long URLs may not wrap as a
hyperlink and you may need to cut and paste.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Marine wound infections
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The sea and seashore can produce many unusual
infections associated with diving, fishing,
handling fish or seafood or even just cutting your
foot on a seashell. These unusual infections can
be from bacteria, mycobacterium, protozoa and
viruses. Most inland doctors are not very aware of
these organisms and the treatment needed. Skin
infections and cellulitis are the main disorders
you may acquire although eye, ear and even rarely
meningitis types of infections can crop up. If you
return from the beach or your Caribbeann vacation
with a cut that looks red, you need to be careful
if it looks like the infection is not quickly
clearing.
Among these unusual infectious agents are:
Vibrio vulnificus
Vibrio parahaemolyticus
Erysipelothrix rhusiopathiae
Aeromonas hydrophilia
Mycobacterium marinum
Acanthamoeba
Pfiesteria piscicida
Giardia lamblia
Endamoeba histolytica
Hepatitis A virus
The following information at Diving Medicine
Online is handy to have available if you are
suspicious of a marine infection or spend a lot
of time around the ocean or lakes.
Bacterial infections and diving
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Effective treatment of hypertension
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did you know that less than a third of people with
hypertension have their blood pressure under
control? Its not because treatments are
ineffective but rather due to how we comply with
diet, weight loss and pill taking regimens.
Low salt (sodium) diets seem to only decrease
blood pressure by 4/1 mm of Hg. A diet rich in
fruits and vegetables and low in total and
saturated fats was found to lower the BP by 11.4
mm Hg systolic and 5.5 mm Hg diastolic in
hypertensive patients. Weight loss diets caused an
average drop of 11/8 mm Hg while combination drug
therapy (usually an antihypertensive medication
combined with a diuretic) resulted in an average
systolic to diastolic drop of 22/12 mm Hg. Also,
dietary therapy only seemed have a short term
effect on the blood pressure and within 5 years,
most of the effects of dietary change disappeared
even though patients still stuck to the diets.
The moral of the story is taking medicine
consistently is much more important than dietary
change in controlling hypertension. This doesn't
mean to throw the diet changes out; just be sure
to take your medicine.
The paper below from the Annals of Internal
Medicine also suggests you are more likely to
comply with taking your antihypertensive
medications if:
1) you had good education in the doctor's office
about treatment when first starting medications
2) a family member is enlisted to monitor your
taking of medication
3) you use a home blood pressure monitor and
record measurements
4) your regimen of medication is a once-daily
dosage
5) nurses reinforce your education at each
doctor's office visit.
Improving Treatment Effectiveness in Hypertension
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Taking ClomidŽ
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"My doctor prescribed ClomidŽ and told me how to
use it but I don't get my period every month. I
have some birth control pills left. Should I use
them so I can start the ClomidŽ?". K.
ClomidŽ (clomiphene citrate) is a "fertility" pill
used to induce ovulation in women with infrequent
menstrual periods due to polycystic ovarian
disease, hypothalamic anovulation and other
situations associated with infertility. There are
different regimens used in order to make the ovary
ovulate.
Usually a menses needs to be induced to make sure
ovulation or pregnancy has not just occurred and
to make sure the lining of the uterus is at the
right phase to receive implantation of the egg.
These instructions and others are discussed at the
article below.
Taking ClomidŽ for Ovulation
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. High caffeine intake and miscarriages
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Various studies using a history of how many
caffeinated beverages are drunk each day have
sometimes implicated high caffeine intake as a
cause of spontaneous miscarriage. This study in
the New England Journal of Medicine measured blood
serum levels of paraxanthine, a caffeine
metabolite, in women with normal pregnancy
outcomes versus women whose pregnancies ended in
miscarriage. They found that at high levels of
caffeine there was a two fold risk of pregnancy
loss.
Although the abstract below does not indicate what
caffeine level is safe, the full-text article in
the Journal reasons indirectly that at less than
the equivalent of 6 cups of coffee per day in a
non-smoker and 11 cups of coffee a day in a smoker
(smoking lowers serum caffeine levels) there was
no increased risk. Therefore the intake of
caffeinated beverages at the equivalent of more
than 6 cups of coffee per day may increase the
chance of miscarriage.
Caffeine metabolite and spontaneous abortion risk
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Thick toe nails
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Thick toenails often represent a fungal infection
called onychomycosis. It makes them brittle and
either white or yellow in color. Moisture, tight
fitting shoes and aging (because the toenail grows
more slowly) are more likely to be associated with
this fungal infection. It is fairly difficult to
get rid of. Terbinafine (Lamisil(R)) is the
medical treatment of choice but partial or
complete nail removal may need to be done. It may
take up to a year or so to see a complete cure
just because toenail growth can take that long.
Toenails infected with a fungus do not present a
health hazard or problem. Mostly it is a cosmetic
problem but also a flag that there may be
underlying diabetes or vascular flow problems to
the feet. More often than not, however it is due
to lack of attention to the feet and to good
fitting shoes.
Thick toenails
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
A big shot business man had to spend a couple of
days in the hospital. He was a royal pain to the
nurses because he bossed them around just like he
did his employees.
None of the hospital staff wanted to have anything
to do with him. The head nurse was the only one
who could stand up to him. She came into his room
and announced,
"I have to take your temperature."
After complaining for several minutes, he finally
settled down, crossed his arms and opened his
mouth.
"No, I'm sorry," the nurse stated, "but for this
reading, I cannot use an oral thermometer."
This started another round of complaining, but
eventually he rolled over and bared his rear end.
After feeling the nurse insert the thermometer, he
heard her announce, "I have to get something. Now
you stay JUST LIKE THAT until I get back!"
She leaves the door to his room open on her way
out. He curses under his breath as he hears people
walking past his door laughing. After almost an
hour, the man's doctor comes into the room.
"What's going on here?" asked the doctor.
Angrily, the man answers, "What's the matter, Doc?
Haven't you ever seen someone having their
temperature taken?"
After a pause, the doctor confesses, "Well. no. I
guess I haven't.
Not with a carnation anyway."
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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***** Woman's Diagnostic Cyber Newsletter *****
December 12, 1999
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Chronic fatigue syndrome and fibromyalgia
2. Herpes management guidelines
3. Reader submitted Q&A - Menstrual seizures
4. Atlas of skin diseases
5. Pregnancy resources brought together
6. Humor is healthy
Spread the word! Send a copy of this newsletter
to someone you know.
Note: Some of the long URLs may not wrap as a
hyperlink and you may need to cut and paste.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Chronic fatigue syndrome and fibromyalgia
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
These two different, poorly diagnosed conditions
both have muscle pain and fatigue as prominent
symptoms. Sometimes doctors mislabel patients
with one condition when their symptoms really fit
the other better.
Chronic fatigue syndrome is a difficult diagnosis
to make. No laboratory tests are helpful. The
diagnostic criteria include:
The new occurrence of chronic or relapsing fatigue
not associated with exertion and a 6 month history
of 4 or more of the following concurrent symptoms:
1) substantial short-term memory/concentration
impairment
2) sore throat
3) tender lymph nodes
4) muscle pain
5) multiple-joint pain without swelling or redness
6) headaches of a new type, pattern, or severity
7) unrefreshing sleep and
8) post-exercise fatigue lasting more than 24
hours.
Fibromyalgia has many of the same manifestations
but the fatigue is due to sleep deprivation. The
location of the muscle pain is very key to making
a fibromyalgia diagnosis.
Classification of Fibromyalgia
Basics of CFS and fibromyalgia
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Herpes management guidelines
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The Association of Genito Urinary Medicine of the
UK has published guidelines for many of the
sexually transmitted diseases. Did you know that
after the first symptomatic episode of genital
herpes, there is an average of 4 recurrences a
year? Genital herpes (HSV) is a condition that can
have confusing treatment guidelines because the
medicines used to treat outbreaks is not always
effective and are relatively expensive in the
doses and courses recommended.
A close look at the treatment guidelines shows
that the anti-herpes medicines of acyclovir,
famcyclovir, and valacyclovir:
---First episode of herpes ---
1) The medicines only lessen the symptoms by about
one day.
2) Creams (topical agents) are even less effective
than pills and not of much use in the first herpes
occurrence.
3) Bathing in salt (saline) solution such as
Artificial Sea from the local fish aquarium supply
store and pain pills are effective supportive
treatments
---Recurrent genital herpes---
1) Women who have 6 or more recurrences a year
experience a significant reduction (about 50%) in
recurrences if they take daily anti-herpes
treatment.
2) Use of these medicines early in the prodromal
phase of an outbreak aborts about 10% of outbreaks
and shortens the symptoms by about 2 days.
3) After a one year trial of suppression with anti-
viral meds, those medications should be
discontinued to see if the recurrence rate has
been permanently decreased.
Herpes guidelines
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Menstrual seizures
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I am trying to find a birth control pill
consisting of only natural progesterone, (not
synthetic). Is there such a thing? Also, would a
natural progesterone pill (or the cremes for that
matter), protect you against getting pregnant?
I am 34 yrs old and suffer from endometriosis, and
seizures. I was put on the pill to help with the
painful cramps, but the estrogen in these pills
causes me to have seizures. I have catamenial
epilepsy, and am taking Neurontin(R) for it."
Catamenial epilepsy refers to the worsening of
seizure frequency during menses. Estrogen can
worsen these seizures while progesterone can
lessen them. Taking hormones for contraception or
menopause can complicate the control of epileptic
seizures.
There are no natural progesterone contraceptives
and progesterone creams will not protect against
pregnancy. See the discussion of contraception and
menstrual seizures.
Menstrual Seizures and Progesterone
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Atlas of skin diseases
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The Dermatology Online Atlas at the University of
Erlangen, Germany, has quite a collection of skin
lesions. It isn't set up to help you diagnose what
a given skin condition might be, but if you want
to look at examples of a known disease, you can
see what they look like and the range of
appearances.
For example, if you think a skin rash might be
psoriasis, you can look under the P's and see:
Psoriasis Arthropathica
Psoriasis inversa
Psoriasis palmaris et plantaris
Psoriasis palmoplantaris
Psoriasis Pustulosa Generalisata
Psoriasis Pustulosa Hypocalcaemica
Psoriasis pustulosa palmaris et plantaris, Barber-
Konigsbeck Type
Psoriasis Vulgaris
Psoriasis Vulgaris, Chronic Stationary Type
Psoriasis Vulgaris, Guttate Type
Psoriasis Vulgaris, Nail Changes
Psoriatic Erythroderma
Please don't use this resource to diagnose your
own skin rash or those of friends. Rather use it
to see the wide range of presentation of skin
conditions and to learn all of the variations and
possibilities for a given disease.
Dermatology online atlas
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Pregnancy resources brought together
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Yahoo.com has entered the health care arena in a
fairly big way, other than just indexing sites, by
gathering their own material and material from
iVilliage.com and others to offer the pregnant mom
a great place to find many related resources.
There is a pregnancy calendar, drug safety lookup
table, send a birth announcement, a baby's name
list selector, baby shower registration and some
frequently asked questions about pregnancy. You
can even build a free web page on Yahoo's
geocities.com for your new baby!
Check out the "what to expect" section for answers
to common questions that arise during pregnancy.
Pregnancy support resources
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Just Like a Surgeon
Morris was removing some engine valves from a car
on the lift when he spotted the famous heart
surgeon Dr. Michael DeBakey, who was standing off
to the side, waiting for the service manager.
Morris, somewhat of a loud mouth, shouted across
the garage, "Hey DeBakey! Is dat you? Come over
here a minute."
The famous surgeon, a bit surprised, walked over
to where Morris was working on a car. Morris in a
loud voice, all could hear, said argumentatively,
"So Mr. Fancy Doctor, look at this work. I also
take valves out, grind 'em, put in new parts, and
when I finish this baby will purr like a kitten.
So how come you get the big bucks, when you and me
are doing basically the same work?"
DeBakey was very embarrassed and as he walked
away, said softly to Morris,
"Try doing your work with the engine running."
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Back to top
***** Woman's Diagnostic Cyber Newsletter *****
December 19, 1999
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Anti-perspirants NOT a cause of breast cancer
2. Gynecologic Endoscopic Atlas
3. Reader submitted Q&A - Recurrence genital warts
4. Perimenopause
5. Risk factors for domestic violence
6. Humor is healthy
Spread the word! Send a copy of this newsletter
to someone you know.
Note: Some of the long URLs may not wrap as a
hyperlink and you may need to cut and paste.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Anti-perspirants NOT a cause of breast cancer
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Rumor spreading now goes faster by email. One of
the inaccurate rumors is about anti-perspirants
being linked to breast cancer. Apparently,
someone's concept of anti-perspirants is that it
blocks toxins secreted by our bodies and those
toxins can cause breast cancer.
While they block some sweat from the underarm
area, sweat is still secreted from many places on
the skin such as hands, soles of feet and the back
among others. The components of sweat such as
salts or urea are not know to be cancer causing.
Read about this email rumor at the Susan Komen
breast cancer web site below.
Email antiperspirant rumor unfounded
If a close family member has breast cancer, they
should be tested for the breast cancer genes -
BRCA-1, BRCA-2. If they are negative, this is
eliminated as a risk factor for you. If they are
positive, you should be tested. There is a good
collection of resources at Facingourrisk.org , a
web site designed for those women who are BRCA
positive or who have a strong family history of
breast cancer.
Facing our risk of cancer empowered - resources
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Gynecologic Endoscopic Atlas
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
For those whose relate better to medical concepts
when they can picture the disease process, you
might want to view these images at the
International Society for Gynecologic Endoscopy.
There are quite a few laparoscopic and
hysteroscopic images of:
Fibroids
Endometriosis
Hysteroscopic Resection
Adhesions
Fimbrial Cyst
Normal View of Pelvis
Stomach and Liver
Appendix
Uterosacral Ligament
Gynecologic images
If you are having a laparoscopy, you may want to
also look at some pages about what to expect when
having a laparoscopy.
Laparoscopy - What to Expect
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Recurrence genital warts
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I've been diagnosed with having HPV (genital
warts). I've had them for over 2 years and since
I've known I had them, I haven't had one day
without them. No treatment seems to work. The
cryosurgery works but as soon as they kill 5, 10
more pop up. What can I do? Is there any way to
stop this? Is there something I can do to help?
Most warts of any type eventually go away. But the
time to clearing is years. It may take up to 5-10
years in children for genital warts to disappear
and probably less than that in adults. Most
treatment is based upon destruction of the wart by
various means but even after long courses of
treatment the recurrence rate can be 20-40%.
Immune stimulation therapy with a patient-applied
cream currently seems to have the best cure rate
and lowest recurrence rate. There are many factors
affecting genital warts, however. For a discussion
of these, see our article at:
Recurrence of warts with different treatments
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Perimenopause
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Perimenopause is a name given to those years
preceding menopause when there may be some changes
in the reproductive hormones and ovulation.
Ovulation is a delicate mechanism that can be
easily disrupted by stress, aging and many
environmental factors. This disruption can produce
symptoms, the most common of which are menstrual
abnormalities. Woman may skip periods or they may
have heavier and more frequent menses. Extra
spotting is not uncommon. On symptoms alone,
anatomical causes of bleeding can present
similarly to perimenopausal bleeding so it is not
safe to assume all bleeding has a hormonal cause.
Breast tenderness becomes unpredictable and
premenstrual irritability can also be worse or
more unpredictable. Pregnancies and STDs are still
possible so protection is needed against those.
While hot flashes can occur before menopause, they
are still relatively infrequent in occurrence.
Sometimes vaginal dryness can also be a problem
before full menopause.
Be sure to ask your doctor for possible treatment
for any of these perimenopausal symptoms if they
are affecting your daily activities or causing
concern.
See the peimenopause brochure at the Association
of Reproductive Health Professionals web site:
Perimenopause
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Risk factors for domestic violence
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Women are very much more at risk of being victims
of physical domestic violence than are men. This
New England Journal of Medicine study looked at
what were the other risk factors among 256 women
who suffered an acute injury from physical assault
by a male partner.
They found the major risk factors to be:
alcohol abuse
drug use
intermittent employment
recent unemployment
having less than a high school education
the partner being a former husband, estranged husband or
former boyfriend,
Risk factors for domestic violence
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
A selection of carols for your dysfunctional
friends:
SCHIZOPHRENIA:
Do you Hear What I Hear?
MULTIPLE PERSONALITY DISORDER:
We Three Queens Disoriented Are
DEMENTIA:
I Think I'll Be Home for Christmas
NARCISSISTIC:
Hark the Herald Angels Sing About Me
MANIC:
Deck the Halls and Walls and House and Lawn and Streets and
Stores and Office and Town and Cars and Busses and Trucks and
Trees and Fire Hydrants and..
PARANOID:
Santa Claus is Coming to Get Me.
PERSONALITY DISORDER:
You Better Watch Out, I'm Gonna Cry, I'm Gonna Pout,
Maybe I'll tell you Why.
DEPRESSION:
Silent Anhedonia, Holy Anhedonia, All is Flat,
All is Lonely.
OBSESSIVE-COMPULSIVE DISORDER:
Jingle Bell, Jingle Bell, Jingle Bell Rock,
Jingle Bell, Jingle Bell, Jingle Bell Rock,
Jingle Bell, Jingle Bell, Jingle Bell Rock,
Jingle Bell, Jingle Bell, Jingle Bell Rock,
Jingle Bell, Jingle Bell, Jingle Bell Rock,
Jingle Bell, Jingle Bell, Jingle Bell Rock,
Jingle Bell, Jingle Bell, Jingle Bell Rock,
Jingle Bell, Jingle Bell, Jingle Bell Rock,
Jingle Bell, Jingle Bell, Jingle Bell Rock,
Jingle Bell, Jingle Bell, Jingle Bell Rock,
Jingle Bell, Jingle Bell, Jingle Bell Rock,
Jingle Bell, Jingle Bell, Jingle Bell Rock,
Jingle Bell, Jingle Bell, Jingle Bell Rock,
Jingle Bell, Jingle Bell, Jingle Bell Rock,
Jingle Bell, Jingle Bell, Jingle Bell Rock,
Jingle Bell, Jingle Bell, Jingle Bell Rock,
Jingle Bell, Jingle Bell, Jingle Bell Rock,
Jingle Bell, Jingle Bell, Jingle Bell Rock,
Jingle Bell, Jingle Bell, Jingle Bell Rock,
Jingle Bell, Jingle Bell, Jingle Bell Rock ........
....(better start again)
PASSIVE-AGGRESSIVE PERSONALITY:
On the First Day of Christmas My True Love Gave to Me
(and then took it all away).
BORDERLINE PERSONALITY DISORDER:
Thoughts of Roasting on an Open Fire.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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